HomeMy WebLinkAbout008-134-00-0200-LUP-1990-254 ' A lication fo X�
yp r Land Use Fermit �
County of Sawyer N
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The undersigned hereby makes application for a Land Use Permit and agrees
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that all work shall be done in accordance with the requirements oF the Sawyer °, �
County Zoning Ordinance and the laws and regulations of the State of Wieconsin.
PRIN'P - USL ONLY DLACK 1NY./PENCIL
JOhh �. � ��nc�a � ��%e�� ��wra-v N
Owner Builder �
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mailing address mailing addzess
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city,�e, zip r_±t1, stato, yir
Building Land Use Zone District �n� �
( ) New ( ) Filling �
(�Addition O Dredging � Lot size ���fp� J( ��J�//7 3 s �
( ) niteration ( ) Grading , � ' m n
( ) Moving on ( ) Acres
( ) ( )
New Construction - VeCk '
Size �L� fC wide ft wide �_D
_�'�13� ft long ft long
Floor area �(�(� sq ft sq ft
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Total hgt � � � to peak x
'""d'"' c�r.P
Stories �
No. of bedrooms � rear lot line or waterline S� �
Lalce- C�e�!'�e
(year round) or (seasonal) i i
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Type of blda or addition �—_ ���� � N �
( ) Dwelling � � �y `�
( ) Garage (1) (2) car i � A's
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( ) Storage building � � � `�
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( ) 6oatlio�se � � �"I
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( ) Livingroom � �`j�j� � �
( ) �edroom � � . �
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( ) Kitchen-dining i �
( ) Porch - enclosed/roofed i i '
(✓�Deck - open � �
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( ) i i ('P
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T e of constraction � -��r' ��
YP _ � � , Q � �O
(�Frame ( ) elock � � 6 -�' —�7 � Z
O Log O Concrete �i 70' wt 25' �00� ��
( ) Pole ( ) Steel -i ��
( ) Metal ( ) `�i i�
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Construction cost $ # ��G�. �� � ��
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Cer. Soil Test 08 �"� I� � r�W e .a�e. � OQ �'
8�'/0 � 33 - - r----cL road ------------------� o I '3
. Sanitaxy Permit o ' -
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Issued 23 October 1990 Denied
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DH conduct d on ite o October 8, 1990 - is at 90' 0 i �
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John Wi owner -�o�ing Administrator C1
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°� SANITARY PERMIT APPLICATION �o�NTY --
� DILHR In accord with ILHR 83.05, Wis. Adm. Code ��� �� @ � �
��"'"""'�"'�" STATE SANIT RY PERMIT # � I
� CST 88 - 198 114454 �, �
-Attach compiete plans (to the county copy only) for the system, on paper not less than STATE PLAN I.D. NUMBER — '` N
8'h x 11 inches in size. S88 - 20435
-See reverse side for instructions for completing this application.
PETITION � YES C� NO
�. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. FOR vaRiaNCE
P�ERTY OWNER PROPERTY LOCATION
�J a a GlJ, L s°F" ,�4 .��-''/4, S T3 , N, R 9 E (or�
PRO�E�TY OW�'�M�LIN��RES$� �� \,� {� LOT NUMBER BLOCK NUMBER p� l!I Ld� Z � �
� �
7 r� T v
�CI Y, STATE ZIP CODE PHONE NUMBER O VIL AGE :� Ps �jq NEAREST ROAD, LAKE OR LANDMAFK
i� Dn/ /IT /�� '" /z � `� tNEG�q�✓ ,B�t� L.�
II. TYPE OF BUILDING OR USE SERVED:
Number of Bedrooms if 1 or 2 Family � OR ❑ Public (Specify):
II1. PURPOSE OF APPLICATION: (Check only one in #1 . Check ## 2, 3 or 4, if applicable)
1 . a. �Alew b. ❑ Replacement c. ❑ Replacement of d. ❑ Reconnection of e. ❑ Repair of an
System System Septic Tank Only an Existing System Existing System
2. ❑ A S�nitary Permit was previously issued. Permit # Date Issued
3. ❑ ,4n Existing System has been inspected and soil conditions meet minimum requirements.
4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. ,
IV. TYPE OF SYSTEM: (Check only one in #1 and only one in #2)
1 . a. ❑ Conventional b. ❑ Alternative c. ❑ Experimental
2. a. ❑ System- b,X� Holding c. ❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP
In-Fill Tank
V. ABSORPTION SYSTEM INFORMATION: (Check one)
1 . a. ❑ See 3 e Bed b. ❑ See a e Trench c. ❑ See a e Pit
2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA b. SYSTEM ELEVATION 6. WATER SUPPLY:
(Minutes er inch): REQUIRED (Square Feet): PROPOSED S uare Feet):
/" �! �� �� �� Feet ,�Private ❑ Joint ❑ 'ublic
CAPACITY
VI. TANK Site
in allons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- plastic Fxper.
INFORMATION New xisting Gallons Tanks Concrete glass App.
Tanks Tanks structed
Se tic Tank or Holdin Tank � ❑ ❑ ❑ ❑ ❑
Lift Pum Tank/Si hon Chamber ❑ ❑ ❑ ❑ ❑
VII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the private sewage system show on the attached plans.
Plumber's Name (Print): Plumber' S ature: (No Stamps) P/ RSW No.: Business Phone Number:
��.���C,�Gd/� . ��� 1�5— ��-�- �.�s
Plu ber's Address (Street, City, State, Zip Code): Name of Designer:
/�'�/�� /v� ��� r�/� S"� � �
VIII. SOIL EST INFORMATION
Certified Soil Tester (CST Name . X 30.6 CST#
� � iM $o � � h Q T !��
CST's ADDR SS (Street, City, St te, Zip Code) Phone Number:
� � �
IX. COUNTYID�PARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee Groundwater Date Issui Agent Signature (No Stamps)
� Approved ❑ Owner Given Initial Surcharge Fee
AdverseDetermination $ 9 � . � � $ 25 . � 0 10 - 25 - 88
X. COMMENTS/REASONS FOR DISAPPROVAL:
-- -- -�
SBD-6398 (formerly Plb-67) (R. 03/86) DISTRIBUTION: Original to County, One Copy Tu: Bureau of Plumbing, Owner, Plumber
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. Application for Land Use Permit
County of Sawyer y
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The undersigned hereby makes application for a Land Ose Permit and aqrees �
that all work sha�l be done in accordance with the requirements of the Sawyer �,
County Zoning Ordinance and the laws and regulations of the State of Wisconsin. t
Patricia E. 2Iid PRINT - USE ONLY BLFICK INK/PENCIL
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�6`� �� ���' / Builder �
�Itl'�/J�✓fI/�Y�� J''r—.'�`�Z.�
ma ling addr ss mailing address ��
Egan, Minnesota 55123
city, state, zip city, state, zip
Building Land Use Zone District RR-1
�New ( ) Filling S �
( ) Addition ( ) Dredging Lot size 180' x 165'/173' rt
( ) Alteration ( ) Grading m r�s
( ) Moving on ( ) Acres •71 C •
( ) ( ) � Q� �
t7
New Construction N � t"
Size fiC� ft wide � wide � 4
�/-� O
�j C/ ft long ft long \`�z .
(O
Floor area /3�� sq ft �� 'v sq ft ��
� �� � �
Total hgt _��' _ to peak to peak x
Stories � /
No. of bedrooms � rear lot line or wate lin �
(year round) oxx��xxX '`�� — " �
i..� /6� i c�
Ty-p/e of bldg or addition i i cn C
(y' Dwelling � � �- "�
i. i
O Garage (1) (2) car i i °'o
( ) Storage building i i r.rt
( ) Boathouse � � `�
i_ � r
( ) Livingroom �
i i �
( ) Bedroom � �
f i
( ) Kitchen-dining i i
( ) Porch - enclosed/roofed � �
I I
( ) Deck - open � � �
( ) Q i �`J � i . cn
c )
N � � 0 �'
Type�f construction ��-7� � "'D/��N �
(/��Frame ( ) Block �i � i � z
( ) Loq ( ) Concrete i i� �
( ) Pole ( ) Steel � �`
i i
( ) Metal ( ) � i N
� � i i m
�f i i o
Construction cost $ -�v�' p
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vol 424 pg 185 of deed i I i �
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csM vol Plat Pg Env 78 i � � ��
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Cer. Soil 'rest 88-198 ! /�' i 'J� �
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Sanitary Permit 88-182 --------- --- -
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�ssued 26 October 1988 �enied ^'
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� T�!k k L In�.-i�- - ct6 i.)M_ w
owner Zoning Adminis ato
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